0:52 - Technical Performance of the Block 2:58 - Discussion of Supraclavicular Nerves 4:09 - Clinical Pearls 8:09 - Rationale for Superior Trunk Block vs. Interscalene Block 12:52 - Example of Continuous Superior Trunk Block Catheter 14:35 - Further Examples of Superior Trunk Blocks (3)
As a 2nd year resident in anesthesia, I am literally soaking up your amazing videos! You teach me things that my attendings should be doing if they knew. Keep up the great work! Greetings from Germany!
In the meantime I only need 4-5 ml between C5 and C6 for a complete and Long lasting block . I use the out of plane approach as the plexus usually is no deeper than 1 cm. Advantage of love volume is avoidance if phrenic nerve involvement. 😊
Great Anatomical correlations!!. From the presentation its convincing why Superior Trunk block is better than InterScalene. Of course, its individual choice and what best suits for one, however Anatomical reasons explained in the video is convincing to choose STB.!!Great Job!!
Thanks for another excellent video. Why does a dermatomal strip along the posterior aspect of the arm from just above the elbow to the mid arm escape despite 20 mls of LA in interscalene and 10-15 mls in subclavian perivascular? Found this happening in a midshaft humerus so surgeon infiltrated into the skin at incision and the rest of the surgery was smooth and painless?
This is a common scenario - because the medial upper arm receives innervation from the intercostobrachial nerve (T2) which is not part of the brachial plexus. See 00:50 of my video on distal upper limb blocks (ua-cam.com/video/uy4Vk7A4Jg4/v-deo.html). This can be easily blocked - the trick is to remember to do so!
Fantastic video. Thank you. I wanted to know: how come we don't block the superficial cervical plexus during an interscalene block, but we do for a superior trunk block?
The simple answer is that people don't usually think about it. You would block the superficial cervical plexus / supraclavicular nerves with an interscalene block for the same reasons that are described here - to ensure you cover the cutaneous supply to the cape of the shoulder, as well as the acromioclavicular joint (see ua-cam.com/video/hJe2IPtCo1M/v-deo.html). Having said that, because you are blocking at the level of the roots with an interscalene block, IF you inject a large volume of LA (>20ml), it could potentially spread to the C4 and even C3 roots. In which case you could also get a cervical plexus block, without deliberately targeting it. But you would also guarantee hemidiaphragmatic paresis (phrenic nerve).
Dr. Chin, thank you for the great teaching here. Do you think the supraclav superficial nerve block you describe here would work for helping an awake patient better tolerate central line placement in the unit? I ask b/c a staff has told me in the past that the superficial cervical plexus can help in this situation, so you mentioning AN alternative here piqued my interest. Have you used either block for this specific goal?
It may well do that - but I think it is overkill for IJV CVP placement. Generous SC LA infiltration of the puncture site, coupled with good technique (see my other videos) has always been sufficient in my experience over the years.
Sorry but I don't know what a SeTB is. But ultimately, you can potentially target any individual element of the brachial plexus above the clavicle, and call it something. However, it will only produce a selective block if you limit your volume - which most of us don't do in practice.
Yes, there is no reason why, with the appropriate volume and concentration of local anesthetic, the STB will not achieve the same effect as an interscalene block.
An assistant is usually injecting. The key is to give them very specific instructions. Initially when hydrolocating, just a "puff" on the plunger is enough. Once I am sure the tip is in the right place, I instruct them to inject a fixed volume, e.g. 3ml, fairly rapidly. This will ensure a dissecting jet.
![Difficult Spinal Anesthesia - High-Yield Strategies for Success [ISURA 2023]](/img/n.gif)
0:52 - Technical Performance of the Block
2:58 - Discussion of Supraclavicular Nerves
4:09 - Clinical Pearls
8:09 - Rationale for Superior Trunk Block vs. Interscalene Block
12:52 - Example of Continuous Superior Trunk Block Catheter
14:35 - Further Examples of Superior Trunk Blocks (3)
❤
As a 2nd year resident in anesthesia, I am literally soaking up your amazing videos! You teach me things that my attendings should be doing if they knew. Keep up the great work! Greetings from Germany!
Very good video Dr Chin, greatly appreciate.
Fantastic video and teaching. Really love it. I would recommend this to my colleagues who do blocks.
Excellent video and description! Thank you
Thank you so much for the opportunity to learn with your amazing video
Awesome!!!!! Your videos are always the best. They answered clearly to every questions about doing block. Thank you million times.
In the meantime I only need 4-5 ml between C5 and C6 for a complete and Long lasting block . I use the out of plane approach as the plexus usually is no deeper than 1 cm. Advantage of love volume is avoidance if phrenic nerve involvement. 😊
Great Anatomical correlations!!. From the presentation its convincing why Superior Trunk block is better than InterScalene. Of course, its individual choice and what best suits for one, however Anatomical reasons explained in the video is convincing to choose STB.!!Great Job!!
Thank you for this video. Excellent.
Thanks for another excellent video. Why does a dermatomal strip along the posterior aspect of the arm from just above the elbow to the mid arm escape despite 20 mls of LA in interscalene and 10-15 mls in subclavian perivascular? Found this happening in a midshaft humerus so surgeon infiltrated into the skin at incision and the rest of the surgery was smooth and painless?
This is a common scenario - because the medial upper arm receives innervation from the intercostobrachial nerve (T2) which is not part of the brachial plexus. See 00:50 of my video on distal upper limb blocks (ua-cam.com/video/uy4Vk7A4Jg4/v-deo.html). This can be easily blocked - the trick is to remember to do so!
Fantastic video. Thank you. I wanted to know: how come we don't block the superficial cervical plexus during an interscalene block, but we do for a superior trunk block?
The simple answer is that people don't usually think about it. You would block the superficial cervical plexus / supraclavicular nerves with an interscalene block for the same reasons that are described here - to ensure you cover the cutaneous supply to the cape of the shoulder, as well as the acromioclavicular joint (see ua-cam.com/video/hJe2IPtCo1M/v-deo.html).
Having said that, because you are blocking at the level of the roots with an interscalene block, IF you inject a large volume of LA (>20ml), it could potentially spread to the C4 and even C3 roots. In which case you could also get a cervical plexus block, without deliberately targeting it. But you would also guarantee hemidiaphragmatic paresis (phrenic nerve).
Thanks great video
Excellent video, thank you very much
Great video! Thank you very much. From México.
great! Thank you very much. Especally,caution about suprascaplar n. and a.
Dr. Chin, thank you for the great teaching here. Do you think the supraclav superficial nerve block you describe here would work for helping an awake patient better tolerate central line placement in the unit? I ask b/c a staff has told me in the past that the superficial cervical plexus can help in this situation, so you mentioning AN alternative here piqued my interest. Have you used either block for this specific goal?
It may well do that - but I think it is overkill for IJV CVP placement. Generous SC LA infiltration of the puncture site, coupled with good technique (see my other videos) has always been sufficient in my experience over the years.
Thank you very much
Thank you very much, beautiful class. From Salta City Argentina.
Thanks for the great video, what do you think about SeTB ,is it the same block?
Sorry but I don't know what a SeTB is. But ultimately, you can potentially target any individual element of the brachial plexus above the clavicle, and call it something. However, it will only produce a selective block if you limit your volume - which most of us don't do in practice.
@@KiJinnChin SeBT=selective Truncal Block
Great, sir
Are you saying that the superior trunk block can be used as a primary anesthetic technique with as good of efficacy as interscalene?
Yes, there is no reason why, with the appropriate volume and concentration of local anesthetic, the STB will not achieve the same effect as an interscalene block.
With that volume and LA concentration...will it also block c7?
Hi KJ, could i ask how you inject to get such a lovely hydrodissection jet? (from 16m.17s). Are you injecting yourself or someone else?
An assistant is usually injecting. The key is to give them very specific instructions. Initially when hydrolocating, just a "puff" on the plunger is enough. Once I am sure the tip is in the right place, I instruct them to inject a fixed volume, e.g. 3ml, fairly rapidly. This will ensure a dissecting jet.
Audio is so low??